This is a question that is frequently asked on the herpes forum - folks want to know which treatment is best for them. So how do you figure it out? If you aren't sure if you have hsv1 or hsv2 you need to find that out so that you can better make decisions about treatment. You also need to know what your partner's status is if you have a regular partner. Then you need to do some reading. Both the herpes handbook at www.westoverheights.com
and the herpes info at www.ashastd.org
have terrific info on herpes and treatments to learn more at. Be prepared when you talk to your doctor so that the two of you can make decisions together about how to treat your herpes. Genital herpes treatments are patient driven - the patient gets to make most of the choices about it.
So what are your treatment choices? Well first off - you can chose to do absolutely nothing if you want. You don't HAVE to treat your herpes at all if you don't want to. All recurrences will run their course in about 7-10 days on average ( the first ob usually lasts longer ). You aren't harming your body by not taking the herpes antivirals. some folks get fairly mild ob's and don't mind waiting them out. You can also use topicals for pain relief/comfort too as well as oral pain medications like tylenol or ibuprofen or even aspirin.
Episodic therapy is also a choice. This is when you just treat each ob as it happens. You can use acyclovir, valtrex or famvir for this. Just keep in mind that the antivirals work best when taken at the very first sign of a potential ob so if you start feeling that tell tale tingle/itch or whatever your prodrome is ( if you have one ) start the meds then. No need to wait until you have a full blown ob - the sooner you can start the meds the faster they work. Some folks can even head off a full blown ob if they start medication early enough. On average episodic therapy helps to heal lesions about 2 days faster than doing nothing at all. It also helps to reduce pain faster and reduces shedding faster. If you have questions about doses - see the resources I listed previously or just ask on the board and someone will gladly help you
Even without insurance ( but you still need a provider to give you a prescription), you can get a round of episodic therapy from walmart and similar places for $4. it's a very affordable way to treat herpes recurrences.
suppressive therapy is when you take herpes medications every single day to help reduce the number of recurrences you are having and to help make the ob's you do have milder/heal faster. Suppressive therapy also helps to reduce the chances of transmitting the virus to your partner too if you are in a discordant relationship ( one partner has hsv2 and the other one doesn't ). On average suppressive therapy reduces ob's by 70%. suppressive therapy is an option no matter how many ob's you are having. there isn't some magic number that you have to wait and see how many ob's you are having before you can start it. for some folks just 1 ob a year is too much for them to deal with. for others it might be never having an ob that they are aware of and just wanting to reduce shedding to help reduce the chances of infecting their partner. It's your choice!
which medication to chose for suppressive therapy? valtrex is the most convenient - most folks only have to take it once a day when they don't have an ob. It's available as a generic now in the US and Canada. Famvir has also recently been released in a generic form so depending on your insurance it should be more affordable now too. You need to take it twice a day. Acyclovir is the old tried but true but it's also the medication that all other herpes meds compare themselves to. It's been available in a generic version for a long time now and is usually the most affordable option. You have to take acyclovir twice a day suppressively. you can get acyclovir for under $20/month in the US even if you don't have insurance. you still need a prescription from your provider for all 3 herpes antivirals.
How to make treating your herpes more affordable? Well if you have insurance look into your options. If you have a copay - many insurances have a mail order pharmacy program that if you utilize it you can save money on your co-pays ( and it also beats going to the local pharmacy each month too ). Oftentimes if you order your medications in a 3 month at a time supply you also save money. If you don't have insurance - shop around! Some stores offer different medications at different prices and make it worth refilling your prescription at one vs another. If you are treating your herpes episodically - walmart and other places offer their $4 prescriptions. For walmart it's 200mg tablets , 30 at a time ( I know -the amount makes no sense at all - do you hear me walmart??? ). Since taking 200mg 5x/day for 5 days is a hassle - talk to your doctor about writing the prescription so you can get the cheaper price but how you can take more than 1 pill at a time and only have to take pills 3x/day for either 2 days or 5 days. Like I said previously, all 3 herpes antivirals are available as a generic now so they are cheaper than before, especially if you have prescription coverage with your insurance. Also if you are unemployed and don't have insurance and money is limited, check out the bridges to access program through GSK. Your provider has to enroll you and they need some basic info to do so from you but they are still offering valtrex free if you qualify. I know novartis who makes famvir also has a similar discount program too. There are options !
Ask any questions on the forum that you have